Understanding Microcultures of Health: It’s Time for a ‘Deep Dive’ into Culture & Social Networks to Produce Lasting Health Change

Jan 6, 2015, 9:00 AM

Jason M. Fletcher, PhD, is associate professor at the La Follette School of Public Affairs, Department of Sociology, Department of Agricultural and Applied Economics, and Department of Population Health Sciences at the University of Wisconsin-Madison. He is an alumnus of the Robert Wood Johnson Foundation Health & Society Scholars program at Columbia University, where he researched the intersection of health and social networks.

While an important priority for improving health and health care in the United States is in focusing on broad notions, such as creating a Culture of Health, there is also a need to consider targeted approaches that make use of the structure of relationships that influence health. Most people consider only a small number of social contacts when discussing important matters. Even though our Facebook friends number in the hundreds or thousands, the number with whom we share close and regular geographic or social space is considerably smaller. Network science is leading the way in uncovering what our microcultures look like and how they operate; these findings should be put to further use to improve population health.

These “small worlds” of influence are known to have substantial impacts on health—as shown by numerous careful, gold-standard empirical studies. College freshman who are randomly assigned a roommate who binge drinks are more likely to binge drink, themselves. Adults whose spouses stop smoking through a clinical intervention are themselves much more likely to stop smoking. These positive and negative impacts on health spread not through broad culture but through the “microcultures” of close social ties.

The usefulness of microcultures will depend on how we think health behavior change can best be accomplished. If we believe that a lack of information—about the dangers of smoking, the best hospital, the importance of a healthy diet—is a key factor for why we see poor health outcomes, then using broad culture outlets to make the information case, and relying on so-called “weak” social ties (i.e. acquaintances, but not best friends) is a useful strategy.

On the other hand, if we believe that social norms and sanctions, especially by people we care about (microcultures) are important factors influencing high rates of binge drinking among college students, the growing obesity epidemic, and the persistence of high rates of smoking and teenage pregnancy, then a different set of approaches and understandings is necessary. Importantly, these behaviors (and others) are fundamentally shared activities, often requiring close friends and colleagues to value and support. People smoke, eat, drink, and have unprotected sex with people they are close to—and without the reciprocity of values and norms, the activities might largely disappear.

What would this shift to understanding and intervening on microcultures, rather than broader cultures, mean? A few thoughts: First, it could entail a buddy-system for intervention aimed at behavior change. There is much evidence that access to social support is fundamental to successful interventions for individuals, but programs and interventions are rarely targeted at couples, friends, and other close ties. If done well, this targeting could help more than one person at a time and also remove a key reason for relapsing or other unhealthy behaviors (i.e. a friend’s enabling). A second key step is understanding who “counts” as an important source of information and social norms, and who does not “count.” Broad cultural interventions, such as celebrity endorsements, often fail, as do many advertising campaigns, because the source of the information and/or enticement is too far removed from the individual to feel true and actionable. People respond instead to friends’ testimonials, neighbors’ experiences, and spouse’s requests for change. Leveraging these aspects of social networks might work where other broader efforts have failed.

While the shift from broad cultural change to more subtle and dispersed microcultural change will require more data, interventions, evaluations, and scientific analysis, if done well, it will lead to lasting change and a healthier society.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.

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